††††† NECESSITY, FUNCTION, AND CONFORMITY:
KRS 314.131(1) authorizes the Board of Nursing to promulgate administrative
regulations as may be necessary to enable it to carry into effect the
provisions of KRS Chapter 314. KRS 314.011(10)(c) authorizes the board to
promulgate an administrative regulation to establish the scope of practice for
administering medicine or treatment by a licensed practical nurse. KRS
314.011(10)(a) requires that licensed practical nurses practice under the
direction of a registered nurse, physician, or dentist. This administrative
regulation establishes the scope of that practice as it relates to intravenous
therapy.

††††† (3) "Bolus" means a
concentrated medication or solution given rapidly over a short period of time.

††††† (4) "Central venous access
device" means a device that permits access to the central vascular system
and is inserted with the tip residing in the lower one-third of the superior
vena cava or above the level of the diaphragm in the inferior vena cava.

††††† (5) "Direction" means a
communication of a plan of care that is based upon assessment of a patient by
an advanced practice registered nurse, a registered nurse, physician, or dentist
that establishes the parameters for the provision of care or for the
performance of a procedure.

††††† (6) "Discontinuance" means to
stop the infusion of the medication or fluid and does not include removal of
the intravenous access device.

††††† (13) "Procedural sedation"
means the administration of intravenous medications to produce a state that
allows a patient to tolerate unpleasant procedures and results in a depressed
level of consciousness.

††††† (15) "Supervision" means the
provision of guidance by a registered nurse, advanced practice registered
nurse, physician or dentist for the accomplishment of a nursing task with
periodic observation and evaluation of the performance of the task including
validation that the nursing task has been performed in a safe manner.

††††† (18) "Titration" means
adjustment of a medication dosage or rate of solution infusion as prescribed
within a therapeutic range that is based on the assessment of a patient.

††††† (19) "Vesicant" means an
agent capable of causing injury if it escapes from the intended vascular
pathway into surrounding tissue.

††††† Section 2. Education and Training
Standards. (1) Prior to performing intravenous (IV) therapy, the licensed
practical nurse (LPN) shall have completed education and training related to
the scope of IV therapy for an LPN. This education and training shall be
obtained through:

††††† (a) A prelicensure program of nursing
for individuals admitted to the program after September 15, 2004; or

††††† (b) An institution, practice setting,
or continuing education provider that has in place a written instructional
program and a competency validation mechanism that includes a process for
evaluation and documentation of an LPNís demonstration of the knowledge,
skills, and abilities related to the safe administration of IV therapy. The LPN
shall receive and maintain written documentation of completion of the
instructional program and competency validation.

††††† (2) The education and training programs
recognized in subsection (1) of this section shall be based on "Policies
and Procedures for Infusion Nursing" and "Infusion Nursing: Standards
of Practice" and shall include the following components:

††††† (a) Technology and clinical
applications;

††††† (b) Fluid and electrolyte balance;

††††† (c) Pharmacology and vesicants;

††††† (d) Infection control;

††††† (e) Transfusion therapy;

††††† (f) Parenteral nutrition; and

††††† (g) Legal aspects based on KRS Chapter
314 and this administrative regulation.

††††† (2) For a patient whose condition is
determined by the LPNís supervisor to be stable and predictable, and rapid
change is not anticipated, the supervisor may provide supervision of the LPNís
provision of IV therapy without being physically present in the immediate
vicinity of the LPN, but shall be readily available.

††††† (3) In the following cases, for the LPN
to provide IV therapy, the LPNís supervisor shall be physically present in the
immediate vicinity of the LPN and immediately available to intervene in the
care of the patient:

††††† (a) If a patientís condition is or
becomes critical, fluctuating, unstable, or unpredictable;

††††† (b) If IV medications or fluids are
administered by push or bolus administration, except for saline or heparinized
saline to maintain patency of an IV access device;

††††† (c) If a patient has developed signs
and symptoms of an IV catheter-related infection, venous thrombosis, or central
line catheter occlusion;

††††† (d) If a patient is receiving blood,
blood components, or plasma volume expanders; or

††††† (e) If a patient is receiving
peritoneal dialysis or hemodialysis.

††††† Section 4. Standards of Practice. (1)
An LPN shall perform only those IV therapy acts for which the LPN possesses the
knowledge, skill, and ability to perform in a safe manner, except as limited by
Section 6 of this administrative regulation and under supervision as required
by Section 3 of this administrative regulation.

††††† (3) An LPN shall obtain instruction and
supervision as necessary if implementing new or unfamiliar nursing practices or
procedures.

††††† (4) An LPN shall follow the written,
established policies and procedures of the facility that are consistent with
KRS Chapter 314.

††††† Section 5. Functions That May Be
Performed. An LPN who has met the education and training requirements of
Section 2 of this administrative regulation may perform the following IV
therapy functions, except as limited by Section 6 of this administrative
regulation and under supervision as required by Section 3 of this
administrative regulation:

††††† (1) Calculation and adjustment of the
flow rate on all IV infusions;

††††† (2) Observation and reporting of
subjective and objective signs of adverse reactions to any IV administration
and initiate appropriate interventions;

††††† (3) For all IV access devices:

††††† (a) Administration of IV fluids and
medications via central venous and peripheral access devices as permitted by
this section and not prohibited by Section 6 of this administrative regulation;

††††† (a) Administering Heparin 1:1000 units
or less concentration either to prime the pump, initiate treatment, or for
administration throughout the treatment, in an amount prescribed by a
physician, physicianís assistant, or advanced practice registered nurse. The
licensed practical nurse shall not administer Heparin in concentrations greater
than 1:1000; and

††††† (b) Administering normal saline via the
dialysis machine to correct dialysis-induced hypotension based on the
facilityís medical protocol. Amounts beyond that established in the facilityís
medical protocol shall not be administered without direction from a registered
nurse or a physician;

††††† (12) Collection of blood specimens from
a peripheral IV access device only at the time of initial insertion;

††††† (13) Removal of a noncoring needle from
an implanted venous port;